- An in-home aide is a paid caregiver who provides part-time or full-time support
- In-home aides are also referred to as a Home Health Aide (HHA), Certified Nursing Assistant (CNA), Home Attendant, or Caregiver
- Finding a good match - someone who enjoys the same activities and who you feel comfortable having in your home - is critical
- In-home care is sometimes covered by Medicare in a limited capacity, but is often paid for through long-term care insurance or personal savings
Many of us want to age at home, but find that we may need some help. Sometimes, that help is minor (light housekeeping, someone to who is there in case of an emergency), and others, that help is more significant (getting in and out of bed, bathing). No matter what you need help with, success comes down to finding the right fit.
What Is An In-Home Aide?
An in-home aide is a paid caregiver who provides part-time or full-time support for you or your loved one at home. In-home aides are referred to in many different ways: Home Health Aide (HHA), Certified Nursing Assistant (CNA), Home Attendant, Caregiver, and more. There are also housekeepers, home assistants, and even nannies that might do tasks that resemble what an in-home aide does.
Typically, if you need support and still want to live at home, the alternative to getting an in-home aide would be to have an “informal caregiver” - a family member or friend - who takes on the responsibility.
How Do You Find An In-Home Aide?
There are three main ways to find an in-home aide, including:
- Through a home care agency: In every state, there are hundreds of Home Care Agencies that source, train, and hire aides. They vary widely: some are licensed by the state and some are not, some license and insure workers and some don’t, and some are covered by Medicare and / or long-term care insurance.
- Through a concierge home care company: In many zip codes, there are concierge home care companies that offer a more personalized home care experience. Similar to a home care agency, they hire and train aides, but also typically provide additional services, like on-demand access to nurses, personalized care plans, and even things like household management and light housekeeping. In most instances, these are not covered by Medicare, though many are covered by long-term care insurance.
- Through a private network: The alternative to going through an agency is to find and hire an aide privately, through a referral or word-of-mouth. If you go this route, you will be responsible for all aspects of employing them: hiring, insuring, vetting their credentials, taxes, etc.
Definining Your Needs and Wants
It’s important to define exactly what you need before your search begins, which would include things like:
- Which activities you need help with
- How often you need someone in the home (part-time, full-time, nights/weekends, etc.)
- Any language requirements or cultural preferences
- Gender: a male or female aide
From there, you should think about things that you’d want to have that would make the fit the best it can be, including:
- Interests you’d enjoy sharing (music, sports, etc.)
- Needs for cooking / cuisine preferences
- Any light housekeeping needs
Avoiding Poor Matchmaking
If you’ve ever had someone live in and assist you – as a nanny, housekeeper, au pair, etc. - you know that it can be an adjustment to share your private space.
While there are some people who will not accept home help under any circumstances, a typical reason in-home fails is due to failure around the “match” between the client and the person coming in to assist. This can range from anything from a personality mismatch to a language barrier to a lack of common interests.
So while the “want” category falls second to the “need” category above, it’s important to do your homework and make sure the aide who might be bringing in your home has done theirs. A particularly great match is when a client and aide share a mutual passion or hobby: a love for a certain sports team, movie genre, cuisine, etc. This type of match can allow an aide to provide unobtrusive care and supervision, and often leads to rich friendship and respect.
Questions To Ask
If you’re hiring an aide from an agency, there are some critical questions to ask in the process:
- Is the agency licensed by the state? How long have you been in business?
- What is your training process like? How do you source and recruit aides?
- How do you choose the right aide for a situation?
- What happens if our aide is sick or on vacation?
- What happens if an aide is not the right fit? If we’re having an issue, who can we speak to to resolve it?
Most critical are references: speak to at least two people who have worked with the agency and the individual aide.
Questions are similar with a concierge home care company or a private attendant, though with a private attendant, you’ll want to spend extra time checking their credentials thoroughly.
Paying For Care
The cost of in-home care varies widely by state, setting, and type of care required. Genworth has excellent tools for calculating potential costs in your state. In 2021, the median monthly cost of a home-health aide was $5,148.
Is In-Home Care Covered By Medicare?
Some, but not at all in-home care is covered by Medicare. Here’s what’s covered:
- Medicare pays for in-home care that they deem reasonable or necessary to treat an illness
- This includes skilled nursing care, physical therapy, speech-language pathology services, continuing occupational therapy
- They will also provide Medicare social services (assistance from a social worker or counselor) and certain medical supplies
- Medicare will cover up to 8 hours / day, for a maximum of 28 hours / week (on a case-by-case basis, they will go up to 35 hours / week of coverage if it’s found to be necessary after an assessment)
The home health agency providing care must be certified by Medicare. Prior to your care beginning, the agency should tell you how much of your bill Medicare will pay. Medicare’s official booklet on covering home health care can be found here.
Many people find that the in-home care that they need is not covered by Medicare or Medicaid. They use savings and long-term care insurance to pay for this type of care.